The trend over the past couple months with regards to total numbers of new official Ebola cases in West Africa seems to have leveled between 800 and 1200 cases per week, however it was recently reported that the total number of officially reported cases for the region has fallen to around just 100 per week. Nonetheless, there are probably a similar number of unreported cases (possibly a hundred or more a week) as some recognized cases do not have contacts with any other known Ebola cases.

If contact tracing requires isolating 10-20 people with whom 1,000 new cases per week had had contact, this would mean isolating and monitoring some 10,000 to 20,000 people, just for these new infections. Nonetheless, due to the decrease in the number of new cases in Liberia, there has been some reported success with stopping new emerging clusters of Ebola in isolated areas by isolation of exposed contacts.

Estimates of Future Impact of Ebola Epidemic

It appears that the number of new Ebola cases per week has "stabilized" at approximately 1,000 cases per week.

Patient Zero

It is believed that the epidemic began when a two year old child was infected with Ebola through unknown means and died on December 6th, 2013, in a small village in Guinea which is also geographically close to the borders of both Sierra Leone and Liberia.

Transmission of this Ebola strain

Though it is believed that this Ebola strain only spread through direct contact with contaminated bodily fluids of symptomatic patients or corpses of Ebola victims, past experiments on the virus have indicated that Ebola may be passed through large droplets from some animals to others, without direct physical contact. This strain of Ebola is not considered to be able to be spread by airborne transmission to human beings, though it is a highly infectious pathogen with the fluids from corpses of Ebola victims being especially infectious.

In past weeks, some noted virologists have voiced concerns that the Ebola virus, which has been shown to be steadily mutating during transmission among people, has a very small, but finite risk, of mutating into a form of Ebola which could infect people via airborne transmission.

Sexually Transmitted Ebola Question

It has been said that it is possible that Ebola virus may remain viable in the testes up to 3 months after a person has recovered from the virus. Ebola DNA has been found in semen 7 weeks after recovering, and in vaginal fluid weeks after recovery. Some doctors believe that Ebola can remain in semen and vaginal fluid for months after infection, and these facts have prompted experts to advise against unprotected sex 3 months after recovering from Ebola.

Given that high number of Ebola survivors, perhaps as many as 6,000 Ebola survivors may be living in west africa, (with the majority infected in the last 2 months), sexual transmission of Ebola, even a small number of cases, would be an important mode of transmission to address as soon as possible.

Some believe that the sexual transmission of Ebola might already be an important mode of transmission, and such transmission might play a role in the recrudescent epidemic in Guinea.

Roadblocks to isolating and treating Ebola patients in this outbreak

Reasons for the suspected large number of unreported cases includes, but is not limited to, stigma associated with Ebola and reluctance to seek medical care, a lack of suitable hospitals beds/quarantine wards for Ebola patients in some locales, the similarity of Ebola symptoms with common endemic tropical diseases such as malaria and Lassa fever, leading to a delayed diagnosis of Ebola, the perception that doctors can do nothing to treat Ebola, and the circulating conspiracy theory that Ebola is a cover story for more nefarious activity, such as a scam by the government in Liberia to obtain international funding, or for foreign aid organizations which some believe invented the Ebola epidemic to coverup cannibalism or organ theft.

Weeks ago, in the West Point neighborhood of Liberia, hundreds of Ebola protestors raided an Ebola quarantine unit, causing approximately 30 positive Ebola patients to flee, and the protestors also looted blood and feces contaminated sheets and mattresses which may be contaminated with Ebola.

Healthcare issues in Ebola hit countries

The medical care of other serious diseases prevalent in West Africa, such as malaria, is being neglected, partly due to a lack of healthcare workers, and also due to the focus on Ebola. There were two separate Ebola outbreaks in 2012, unrelated to the present outbreak, and it is possible that at some point various aid organizations may have to deal with concurrent Ebola outbreaks in 2014 or 2015.

Deaths per day of tropical diseases prevalent in Ebola hit countries

Ebola Deaths: Unknown, officially about 100 deaths per day in the 3 countries combined, possibly 4 times higher with 400 Ebola deaths per day as many bodies are being buried without an official Ebola test.
Lassa Fever Deaths: 14
Tuberculosis: 110
Diarrhoea: 404
Malaria: 552
HIV/AIDS: 685

Obviously, these are just averages, and since malaria season has begun, and given the lack of medical care for non-Ebola conditions in some countries, the numbers for non-Ebola deaths may be significantly higher.

In a response to the failure to locate 17 ebola patients who fled after the Ebola protests and raiding of an Ebola treatment center in the neighborhood of West Points, a high density population living in temporary shelters without plumbing in Monrovia Liberia, the WHO organization has asked that all west african countries with Ebola cases begin ‘exit screening’ of travelers leaving these countries such that those suspected of being infected with Ebola are not permitted to leave.

Furthermore, the Liberian government has quarantined said neighborhood, which may be home to 50,000 to 100,000 people living in a crowded and poverty stricken condition. There are reports that the Liberian military used live rounds to deter residents from overrunning blockades.

In a prospectus in the New England Journal of Medicine, Dr. Anthony Fauci notes that the borders of ebola affected countries are porous. This may well limit the effectiveness of a variety of travel restrictions being used in these countries.

Paramount to identifying arriving Ebola carriers in the United States is a suggestive travel history and a high index of suspicion. The top six most common symptoms are fever, weakness, diarrhea, nausea and vomiting, abdominal pain and headache.

MSF opened a new Ebola treatment center in Monrovia, which has 32 patients, and will eventually hold 110 patients once local staff is trained, though MSF does not expect this to meet the need, as per MSF:

“The needs of Ebola patients are greater than our capacity and it’s likely it will remain that way for quite some time,” says Shenk. “That’s why the center was constructed, and it’s certainly the case that there are few places where people can be admitted as Ebola patients in this city.”

One epidemiologist predicted that up to 30,000 people could benefit from an experimental Ebola drug or vaccine, this would include those infected and those at risk of infection. The company that makes ZMapp, an experimental Ebola that provides passive immunity in the forms of three human monoclonal antibodies, is ramping up production with U.S. government help, though it may take a while before more doses are available.

Five years ago, an infectious disease doctor studying Lassa fever in western Africa found evidence in two individuals in West Africa of recent (though presumably not infectious) Ebola Zaire exposure. This might indicated that one, or more, Ebola strain Zaire outbreaks have occurred in the past in western Africa, but only the most recent was able to infected a large number of people. It might also suggest that Ebola Zaire has established itself among a local reservoir population of animals, such as fruit bats, in western african.

Democratic Republic of Congo (DRC) Ebola Outbreak

It has now been reported that the Ebola virus circulating in the DRC is different from the one causing the pandemic in West Africa, though both are the Zaire strain of virus. The Ebola strain currently circulating in the DRC is most similar to one that circulated in the DRC in 1995. There have been 62 cases, and 35 deaths.

The WHO estimates that the total number of reported Ebola cases may hit 20,000 in West Africa at some point, and estimates that the true number of Ebola cases in West Africa could be 2-4 times the official numbers being reported. Under this scenario, with 3,000 known cases, there could actually be as many as 12,000 Ebola cases since the pandemic occurred, with 6,000 of these new cases occurring approximately within the past month. As NGO's, and world bodies such as the WHO, are having difficulty scaling up operations in West Africa, it is certainly possible that the actual number of Ebola cases will rise to 40,000 to 60,000 cases within the next 3 to 4 months, with lower officially reported numbers.

Recently, MSF warned that only recently have world bodies such as the WHO taken the Ebola epidemic seriously, and ominously MSF said that due to the large influx of patients, they are no longer able to administer IV fluids, a cornerstone of supportive care for sick Ebola patients, presumably leaving the organization to focus on testing and isolation of Ebola positive patients in order to prevent the spread of the pandemic.

Mego Terzian with Doctors Without Borders has said that the World Health Organization can’t handle the current outbreak and that, "I don't see how with the current measures how we're going to control the outbreak and stop the outbreak.” He has called for the UN Security Council to take-up the issue and has noted that there are countries with military medical units that could be useful.

The perception that Ebola centers can do little to help patients has kept hundreds, if not thousands, of Ebola patients away, preferring instead to remain in the care of relatives, some even actively avoiding detection by governmental authorities. Should an effective Ebola treatment become available, such as ZMapp, it might decrease the Ebola mortality rate, at least in the recently infected, and restore trust in the healthcare system.

MSF recently said that local governments, the UN, WHO, and various NGOs, such as MSF, don't have the capacity to deal with the scale of pandemic. Other players, such as The U.S. Office of Foreign Disaster Assistance, which normally are not involved in disease outbreaks, have begun to offer assistance to effected regions as part of an "all hands on deck" response to the pandemic.

When you consider the number of deaths from other medical conditions such as HIV/AIDS, malaria, and other diseases and possibly malnutrition in the coming months, that are indirectly due to healthcare resources being focused on Ebola, the pandemic may approach the scale of a humanitarian crisis such as the Haitian earthquake.

Senegal Reports First Ebola Case

Senegal recently reported that a student from Guinea who tested positive for Ebola was secretly living in their country for about three weeks. Twenty of this person's closest contacts have been put in isolation and are being observed.

Sierra Leone
The WHO closed an Ebola testing facility in the country after one of its workers became infected. Health workers in an area of Sierra Leone heavily effected by Ebola have gone on strike due to poor working conditions and low pay. The government of Sierra Leone stopped paying the $50 a week salary of some health workers, and workers report that the clothing to protect them from Ebola is inadequate, and that there is only one stretcher to transport both patients and corpses. It is known that corpses of deceased Ebola patients are highly infectious.

Guinea
There was recently rioting in Guinea after a rumor circulated that the government was spraying a market place in order to purposefully infected people with Ebola.

Nigeria
Despite the appearance that the Ebola epidemic in Nigeria is under control, the government of Nigeria has decided to build some Ebola/isolation treatment centers in anticipation of other cases, hundreds of people in Kaduna Nigeria came out to protest this move by the government, saying that they would rather burn down the Ebola treatment center than have it built in their neighborhood.

Liberia

In the West Point neighborhood of Liberia, the government lifted the military enforced quarantine of the area, which in any cases didn’t prevent the movement of people in and out of the neighborhood as residents could bribe guards to enter and leave the area, and at least one resident in a building near the perimeter was charging people to come and go through his apartment.

Many residents of West Point don’t believe that there is ebola in the neighborhood, and some believe that the government lifted the quarantine because they didn’t find ebola in West Point. Public health experts warned that the quarantine could exacerbate the pandemic's spread.

A video shot in Monrovia shows a man who tested positive for Ebola who escaped a treatment center, apparently to find food in a local market. One woman says that the Ebola patients aren't being fed. At the end of the video, it appears that a mob tackles one of the yellow clothed Ebola treatment center workers, knocking this person to the ground as the truck speeds off.

Alessandro Vespignani at Northeastern University has predicted that there will be 10,000 cases of Ebola by September 24th, and hundreds of thousands in the months after that. Vespignani says that his model assumes that control efforts aren’t increased.

Christian Althaus of the University of Bern predicts that should the epidemic in Liberia continue as it has been, by December 1st there will be 100,000 cases.

Caitlin Rivers of the Virginia Polytechnic Institute and State University in Blacksburg expects roughly 1000 new cases in Liberia in the next 2 weeks and a similar number in Sierra Leone.

WHO Short-term Road Map Plan Ambiguous

The WHO has recognized that traditional methods of Ebola outbreak containment, relying upon contact tracing and isolation of contacts, won’t be wholly effective as WHO’s Bruce Aylward said, "We can't contact-trace every individual.”

In addition to as much contract tracing and treatment centers as is feasible, the WHO has called for, “short-term extraordinary measures to limit national spread,” but WHO has not elucidated specifically what these measures are.

The WHO predicts that in December the spread of infection will have slowed such that contact tracing of individual patients will become effective again, nonetheless, experts modeling the pandemic predict that by December the number of cases will have increased several fold.

It is thought that quarantine zones can exacerbate the pandemic by criminalizing Ebola infection and providing an incentive for people to hide their illness.

Cordon Sanitaire

Laurie Garrett, a senior global health fellow on the Council on Foreign Relations, has advocated (perhaps controversially) the use of strategic quarantine zones, what she calls the “heartless” yet effective cordon sanitaires, such as those used by Congo’s former dictator, Mobutu Sese Seko, in 1995 to stop an Ebola outbreak in the Congo in that year from spreading to the Congo’s populous cities.

Whether the WHO advocates for quarantine areas or not, this seems to be the de facto state of affairs as other countries in Africa have closed borders to affected west african countries.

Garrett says that the current quarantine areas inside these three countries, around the largely rural area where Ebola first emerged in this pandemic, will be largely ineffective as they don’t address the spread of Ebola in heavily populated cities such as Monrovia, Freetown and Conakry.

Garrett further speculates that if the governments of affected countries had provided military support to MSF early in the pandemic in order to isolate affected villages, it might have been possible to have prevented the spread of Ebola into larger cities.

MSF has asked for military disaster response units to be deployed to West Africa:

"To curb the epidemic, it is imperative that states immediately deploy civilian and military assets with expertise in biohazard containment. I call upon you to dispatch your disaster response teams, backed by the full weight of your logistical capabilities. This should be done in close collaboration with the affected countries. Without this deployment, we will never get the epidemic under control."

Dr Joanne Liu, MSF, Tuesday, September 2st, 2014

In response to the use of military resources, Gayle Smith, Special Assistant to the President and Senior Director for Development and Democracy on the National Security Council, said,

Gayle said the U.S. government was focusing efforts on rapidly increasing the number of Ebola treatment centres in affected countries, providing protective equipment and ensuring local staff received training, and added:

"We will see a considerable ramp-up in the coming days and weeks. If we find it is still moving out of control, we will look at other options."

Another hub of infection has been discovered in Nigeria
An infected doctor who traveled to Port Harcourt Nigeria, and came into contact with numerous community members, saw patients, and even operated on two of them, has triggered another Ebola cluster in Nigeria, a country where it was thought the local Ebola epidemic was under control. 60 people are under surveillance, and another 140 are being monitored in Port Harcourt, and two have died in this Ebola cluster. The WHO has said that given the unusually high number of contacts that the doctor had with community members, the epidemic in Port Harcourt could spread much more quickly and broadly than the one in Lagos, which for all appearances is controlled.

MSF (Doctors Without Borders) has called on industrialized countries to send military units specialized with biohazard containment to West Africa.

However, while the European Commission’s Humanitarian arm (ECHO) has also called for military medical units to help, Jorge Castilla-Echenique of ECHO has said that the cost of said units if provided by the Americans would be $114 million per year for a 50 bed unit run by the US military, due to stringent protocols to protect American military personnel, but perhaps cost as little as $11 million per year if run by other organizations.

If there are 500 new infections in Liberia each week, at this point in time, which might mean 2,000 bed needed if patients stayed about a month, then it would cost the US military approximately $1.1 billion to maintain 2000 dedicated Ebola hospital beds in Liberia for three months, though such an investment would have the most impact now in this exponential growth phase of the Ebola epidemic.

Castilla-Echenique also stated ECHO’s position on logistical support:

“The European Commission wants [US] Army and Seal protection teams to come here and produce an air bridge to keep the health workers and aid flowing. I’m talking about a M.A.S.H. like operation,”

As Liberia is approximately one half of the emerging Ebola cases at this point in the epidemic, to provide hospital beds for just the known Ebola patients would probably cost $2.2 billion, (assuming the resources are available to provide 4,000 beds), over the next three months, though this might be one of the few options to significantly dent the momentum of epidemic to date. If the true number of Ebola cases is 2-4 times the official numbers, than there might be an absolute need for maintaining as many as 16,000 Ebola hospital beds, at a U.S. military cost of perhaps $8.8 billion (assuming that many healthcare personnel can be mobilized by the U.S. military), or perhaps as little as $880 million if lower cost hospital beds could be provided and staffed.

WHO's Chan on health care worker needs

Margaret Chan from the WHO said that besides doctors and nurses, there is a need for burial teams, though such jobs are often filled by local people, such as how MSF uses local manpower. As there are many people who have survived Ebola in West Africa, and are presumed to now be immune to Ebola, one wonders if there is, or should be, a concerted effort to involve this local population in corpse disposal and other tasks.

Chan estimates that it takes 200 to 250 healthcare workers to take care of just 80 Ebola patients.

Calls for Military to Protect Health Workers

“Due to the weak health system in Mano River basin, our best option will be to get outside military help to the response,” said Suafiatu Tunis, a spokeswoman for Community Response Group, a grass-roots initiative to combat Ebola in Sierra Leone and a leader of the Social Mobilization Committee on Ebola that reports to the National Task Force. “Even our health workers no longer want to work in our health centers because of lack of safety for them…so in my opinion having the military come in will help our region immensely.”

Ebola Epidemic Could Continue for More Than a Year

Dr. Daniel Lucey, a viral outbreaks expert who spent three weeks in Sierra Leone, and who is a professor at Georgetown, believes that the Ebola epidemic will probably continue for more than a year, and that without effective Ebola medications or vaccinations, that past methods used to contain Ebola in isolated rural areas may not be able to stop the epidemic.

Lucey also suggests that regional “command centers” should be established to make sure that needed supplies, such as gloves and goggles, are available to hospitals that urgently need them.

In an eye opening piece in the New York Times, Dr. Margaret Chan called it a “fantasy” to think of the WHO as a first responder ready to lead the fight against deadly outbreaks around the world after she was approach by an MSF official regarding the Ebola epidemic.

Chan in another recent NYTimes article said,

“First and foremost, people need to understand W.H.O. W.H.O. is the U.N. specialized agency in health. And we are not the first responder. You know, the government has first priority to take care of their people and provide health care. W.H.O. is a technical agency.”

The New York Times reports that doctors who worked with the WHO initial effort to tackle the Ebola epidemic described the WHO’s effort as poorly lead and limited, contributing to a sense that the problem was not as bad as it actually was.

Early in the outbreak the WHO criticized MSF for describing the outbreak as being “out of control”, and some in the organization appeared to have assumed that this Ebola outbreak would follow a limited course similar to other past outbreaks.

Dr. Chan has described the WHO’s role by saying that national governments have a “primary responsibility” to take care of their own people, and described the WHO as a sort of consultancy which provides advice and support, but not on the ground direct care.

The WHO’s disaster response capability had been substantially defunded in the wake of the global recession, and some say was never well funded to begin with.

Dr. Chan describes the rocky relationship between WHO and organizations like MSF as primarily due to a misunderstanding of the function of the WHO, and MSF and others asking WHO for things that the organization doesn’t provide.

After realizing that the WHO can’t do the sort of work that needs to be done to stop the Ebola epidemic, MSF is now soliciting the help of the militaries of industrial countries, such as the US, that could in theory provide military medical units to stop the epidemic.

US Military Plans to Open Small Ebola Field Hospital In Liberia, Britain to follow suit in Sierra Leone.

Under President Obama’s leadership, the US military will airlift a portable 25 bed hospital to Liberia’s capital city, Monrovia. Somewhat surprisingly, it has been reported that the US military will not have a “permanent” presence at the facility once it’s construction has been completed, and that the facility will be handed over to the Liberian government when completed.

The Pentagon did say that the military would have periodic contact with the facility, and maintain a supply line to said facility. A specialized unit in this facility will care for healthcare workers infected with Ebola, and might be used as a testing ground for two trial vaccines starting this November.

Army Colonel Steve Warren, a Pentagon spokesman, said the military's role would be to set up the hospital and then hand it over to the Liberian government to operate. He said there was no plan for U.S. military involvement in providing medical treatment, though the US military may provide security for some aid workers.

"The intent of this piece of equipment is to provide a facility that healthcare workers in the affected region can use for themselves if they become ill or injured," Warren said.

In addition, the British government will open a 62 bed facility in Sierra Leone.

WHO asks Aid Organizations to Dramatically Step-Up Response

A WHO team recently concluded that 1,000 hospital beds are needed in Liberia, and thousands more new Ebola infections are predicted to occur in the coming three weeks in Liberia. The WHO has asked that key aid groups operating in West Africa increase their efforts by 3 to 4 fold.

US Navy Hospital Ships Not Yet Deployed to West Africa

The US Navy has in its possession two hospital ships which have a 1,000 bed capacity each, the USNS Mercy and the USNS comfort. Probably one of the few interventions which could drastically decrease the number of new Ebola infections in Monorovia Liberia (off the coast of Africa) would be for the US Navy to send both of its hospital ships to West Africa, and perhaps commandeer a cruise ship in order to use the rooms for overflow quarantine isolation, assuming that thousands of new cases of Ebola will flood the region in the coming week.

Sierra Leone Government Planned Lockdown

In a planned lockdown heavily criticized by aid organizations fighting the Ebola virus, Sierra Leone’s government plans on restricting non-essential travel between September 19th and 21st, telling residents that they will not be allowed to leave their homes. MSF is concerned that the lockdown will drive the Ebola epidemic further underground and do little to limit its spread.

The WHO is now announcing that they will focus on the relatively smaller Ebola outbreaks in Senegal and Nigeria, with the hope that resources spent here will have the most bang for the buck and stop the further spread of Ebola across the continent. WHO will use contact tracing and quarantining in order to monitor and control the Ebola epidemic in these countries.

In more heavily hit countries, such as Liberia, WHO is recommending that communities be trained to take care of Ebola patients, versus care in isolated facilities. As WHO’s Pandemic and Epidemic Diseases Director Sylvie Briand said:

“Everybody prefers to be hospitalized close to their home and still have contact with their family and their friends rather than being really isolated very far away from where they live," Briand said. "So ... we plan to offer to these people a place where it is safe, where they can receive basic care, rehydration, anti-malarial and supportive care.”

However, given that isolating patients, however uncomfortable, is an integral part of decreasing the spread of the virus, it is unclear if such efforts would actually help slow the epidemic. Equally unclear is how a large number of Liberian communities could be trained to use protective equipment, and whether such equipment would even be available on a consistent basis.

Though the WHO has advocated the use of convalescent transfusions for the treatment of Ebola patients, it is doubtful that many, if any, facilities in heavy hit countries such as Liberia have the manpower to do the work of typing blood and transfusing patients, to say nothing of having adequate space to house recovered Ebola patients.

MIilitary sources have said that the Navy will *not* be sending the Naval Hospital ships, the USNS Mercy and the USNS Comfort, or any of the amphibious ships as used in the Haitian earthquake, to Ebola stricken countries because of the fear that Ebola could spread easily in close quarters. Military sources have also said in past weeks that the US military does not have the expertise to deal with hemorrhagic diseases such as Ebola, despite MSF’s insistence that the US military does have the logistical know-how and technical skills to deal with this outbreak.

Nonetheless, President Obama will visit the CDC on Tuesday, and is expected to announce a scale-up in US military operations in West Africa after the announcement of the delivery of a portable 25-bed field hospital, which was poorly received by aid organizations such as Doctors Without Borders (MSF) whom expected a larger investment.

Larger numbers of people with Ebola symptoms are being turned away from full hospitals across the region. MSF, operating a field hospital near Monrovia with 160 beds estimates that they need 1,200 beds just in that region of Monrovia, and the healthcare workers to staff them.

Black Market Convalescent Serum

A black market for the sale of convalescent serum has emerged in the region, and as disease such as HIV are prevalent in the region, (and as those operating in the black market sale of this product probably don’t have the proper training to safely administer the serum), the WHO is opposed to this new activity.

WHO Will Not Evacuate Sick Sierra Leone Doctor to Germany

The WHO will not, or does not have the funds needed, to transfer a sick Sierra Leone doctor, Dr. Olivet Buck, from Sierra Leona to a hospital in Germany. Dr. Buck might have been the first local physician to be evacuated from Ebola hit countries, instead the WHO has opted to treat her in West Africa and make available to her any experimental Ebola therapies which might help her condition.

*Update, Dr. Olivet Buck died on Saturday in Sierra Leone, so it might be possible that she was too sick to evacuate to another country.

Possibly Hundreds of Thousands of Ebola Cases by Year’s End

Gerardo Chowell-Puente, Arizona State University, Hiroshi Nishiura University of Tokyo, have predicted that there will be between 77,181 to 277,124 Ebola cases by the end of 2014 in West Africa, though this is a worst case scenario in that it assumes that the number of hospital beds are not significantly increased. The researchers noted that past Ebola outbreaks, such as the 1995 outbreak, were initially exponential in their beginning phases as well, and that this outbreak will be harder to control as it is not occurring in an isolated village.

Francis Smart, Michigan State University, has predicted that without a ramped up intervention effort, in six months there could be 1.2 million deaths and 4.7 million infections. He says that the WHO’s 20,000 total case estimate is based upon the world’s aid agencies and governments following WHO’s recommendations for a massive scale-up in treatment and case detection.

President Obama Greatly Expands Planned American Contribution for Ebola Relief and Control in West Africa

President Obama has announced that the US government will build 17 Ebola treatment centers in Liberia, with a capacity of 100 beds each, for a total capacity of 1,700 hospital beds in Liberia. In addition, the US will train 500 healthcare workers a week in Liberia in order to tackle the epidemic, in addition to sending 3,000 American troops to the region.

Nonetheless, the future addition of more hospital beds is not expected to meet the need in Liberia. With approximately 500 official new Ebola infection reported in Liberia each week, this number may double within a month, overwhelmingly new American Ebola centers that will take weeks to be constructed, to say nothing of the large number of undiagnosed Ebola cases that have missed detection.

Besides Ebola, Liberians suffering from malaria and even common pregnancy complications are unable to obtain medical care as Ebola patients have swamped the Liberian healthcare system.

Ken Isaacs, with Samaritan’s Purse an aid organization working in the region, has said that there “simply won’t be enough beds” and that Samaritan’s Purse plans on training families to reduce the risk of catching Ebola while taking care of sick relatives. The US military will also be using this tactic, presumably as 500 healthcare workers are educated per week, and USAID will also distribute kits with equipment such as gloves and sanitizers to 400,000 households in Liberia.

MSF Turning Suspected Ebola Patients Away

In Monrovia Liberia (where the US will establish an Ebola command center), Doctors without Borders (MSF) has been turning away presumed Ebola victims who are desperate to find a place to be isolated so as not to infect their families. Some sources report that 30 people a day are being turned away, forced to return to their communities where they might infect others with Ebola.

The core principle behind past successful containments of Ebola epidemics (mostly in isolated rural villages in central Africa), is the rapid isolation of infected patients and tracing of patient contacts. This is the most efficacious manner in which the number of Ebola infections can be decreased, and an epidemic brought under control. It is unclear if the international response in West Africa will succeed in catching up with the growing number of Ebola cases. If not, then it might be presumed that hundreds of thousands of people will eventually become infected with Ebola in the region over the upcoming months, and if so, this could facilitate the spread of Ebola out of the region as some citizens of Liberia, Sierra Leone and Guinea might well try to flee their countries if there is no hope of obtaining medical care, or due to growing public panic as the number of infections is expected to markedly increase.

More healthcare workers desperately needed

The WHO has said that 10,000 local health care workers are urgently needed in the region, including those trained in proper corpse disposal, as well as there being a need for 500 experts in infectious diseases. It is unknown how many American military doctors and nurses will be asked to serve in West Africa, but a lack of a ground response has been noted by MSF, whom with some 500 plus hospital beds, is currently the largest provider of care and isolation for Ebola patients.

Design of Future American Ebola Treatment Centers Unclear

It has been noted by some foreign health care workers that suspected Ebola patients are often housed in a common holding pool at Ebola treatment centers, sometimes a courtyard, and though instructed not to touch each other, there is a fear that patients with non-Ebola illness, such as malaria, are catching Ebola in some instances due to overcrowding. It is unclear how the American Ebola treatment centers will be designed, and how much of a risk the treatment centers are for those with symptoms mimicking Ebola infection.

Use of Naval Hospital Ships Still Possible, Timeline for Opening of American Ebola Centers Unclear

Obviously, not all of the 17 separate Ebola treatment centers announced by President Obama will be built at once. Aside from construction issues, there are security issues, as well as work that needs to be done with regards to winning over the Liberian people who have been skeptical of Ebola’s existence and their own government’s intentions.

Despite the delay in opening said treatment centers, the US government has apparently ruled out the use of Naval hospital ships, of which there are two with a combined hospital bed number of 2,000, and which could be deployed to the coast of Liberia much faster than the construction of Ebola treatment centers. Given that the Navy's hospital ships are probably air conditioned, this might provide a force multiplier in terms of the number of hours that doctors and nurses can work given that currently, in Liberia's sweltering heat, workers can only withstand about 90 minutes working in Ebola treatment centers before the heat inside the isolation suits become unbearable.

It is possible, and perhaps even desirable, for the Naval hospital ships to be used for the treatment of confirmed Ebola cases, transported from Ebola treatment centers when they are open, in order to keep as many hospital beds open as possible. There is even a growing of number of healthcare workers who have been exposed to Ebola, are immune, and presumably could work with much less restrictive isolation clothing on said naval ships.

President Obama Greatly Expands Planned American Contribution for Ebola Relief and Control in West Africa

President Obama has announced that the US government will build 17 Ebola treatment centers in Liberia, with a capacity of 100 beds each, for a total capacity of 1,700 hospital beds in Liberia. In addition, the US will train 500 healthcare workers a week in Liberia in order to tackle the epidemic, in addition to sending 3,000 American troops to the region.

Nonetheless, the future addition of more hospital beds is not expected to meet the need in Liberia. With approximately 500 official new Ebola infection reported in Liberia each week, this number may double within a month, overwhelmingly new American Ebola centers that will take weeks to be constructed, to say nothing of the large number of undiagnosed Ebola cases that have missed detection.

Besides Ebola, Liberians suffering from malaria and even common pregnancy complications are unable to obtain medical care as Ebola patients have swamped the Liberian healthcare system.

Ken Isaacs, with Samaritan’s Purse an aid organization working in the region, has said that there “simply won’t be enough beds” and that Samaritan’s Purse plans on training families to reduce the risk of catching Ebola while taking care of sick relatives. The US military will also be using this tactic, presumably as 500 healthcare workers are educated per week, and USAID will also distribute kits with equipment such as gloves and sanitizers to 400,000 households in Liberia.

MSF Turning Suspected Ebola Patients Away

In Monrovia Liberia (where the US will establish an Ebola command center), Doctors without Borders (MSF) has been turning away presumed Ebola victims who are desperate to find a place to be isolated so as not to infect their families. Some sources report that 30 people a day are being turned away, forced to return to their communities where they might infect others with Ebola.

The core principle behind past successful containments of Ebola epidemics (mostly in isolated rural villages in central Africa), is the rapid isolation of infected patients and tracing of patient contacts. This is the most efficacious manner in which the number of Ebola infections can be decreased, and an epidemic brought under control. It is unclear if the international response in West Africa will succeed in catching up with the growing number of Ebola cases. If not, then it might be presumed that hundreds of thousands of people will eventually become infected with Ebola in the region over the upcoming months, and if so, this could facilitate the spread of Ebola out of the region as some citizens of Liberia, Sierra Leone and Guinea might well try to flee their countries if there is no hope of obtaining medical care, or due to growing public panic as the number of infections is expected to markedly increase.

More healthcare workers desperately needed

The WHO has said that 10,000 local health care workers are urgently needed in the region, including those trained in proper corpse disposal, as well as there being a need for 500 experts in infectious diseases. It is unknown how many American military doctors and nurses will be asked to serve in West Africa, but a lack of a ground response has been noted by MSF, whom with some 500 plus hospital beds, is currently the largest provider of care and isolation for Ebola patients.

Design of Future American Ebola Treatment Centers Unclear

It has been noted by some foreign health care workers that suspected Ebola patients are often housed in a common holding pool at Ebola treatment centers, sometimes a courtyard, and though instructed not to touch each other, there is a fear that patients with non-Ebola illness, such as malaria, are catching Ebola in some instances due to overcrowding. It is unclear how the American Ebola treatment centers will be designed, and how much of a risk the treatment centers are for those with symptoms mimicking Ebola infection.

Use of Naval Hospital Ships Still Possible, Timeline for Opening of American Ebola Centers Unclear

Obviously, not all of the 17 separate Ebola treatment centers announced by President Obama will be built at once. Aside from construction issues, there are security issues, as well as work that needs to be done with regards to winning over the Liberian people who have been skeptical of Ebola’s existence and their own government’s intentions.

Despite the delay in opening said treatment centers, the US government has apparently ruled out the use of Naval hospital ships, of which there are two with a combined hospital bed number of 2,000, and which could be deployed to the coast of Liberia much faster than the construction of Ebola treatment centers. Given that the Navy's hospital ships are probably air conditioned, this might provide a force multiplier in terms of the number of hours that doctors and nurses can work given that currently, in Liberia's sweltering heat, workers can only withstand about 90 minutes working in Ebola treatment centers before the heat inside the isolation suits become unbearable.

It is possible, and perhaps even desirable, for the Naval hospital ships to be used for the treatment of confirmed Ebola cases, transported from Ebola treatment centers when they are open, in order to keep as many hospital beds open as possible. There is even a growing of healthcare workers who have been exposed to Ebola, are immune, and presumably could work with much less restrictive isolation clothing on said naval ships.

The UN Security Council, in a precedent setting move, has declared the Ebola epidemic to be a threat to international peace and security, by a 15-0 vote and a recording setting 131 countries sponsoring said resolution, the most ever for a Security Council Resolution. Countries worldwide are urged to send medical personnel and supplies to the Ebola epidemic.

WHO Director Margaret Chan calls the Ebola epidemic, “likely the greatest peacetime challenge” the UN has ever faced. The UN Secretary General, Ban Ki-moo announced the creation of an "emergency UN mission", the U.N. Mission for Ebola Emergency Response (UNMEER), to coordinate the global response which will be international in scope. Airports in Spain and Ghana are to be used as transported hubs, and Ban Ki-moo has called on private airlines and shipping companies to resume service to effected west african countries.

The WHO, which has reduced logistical capabilities compared to earlier years, will draw upon other UN bodies for logistical support.

Team of Journalists and Medics Presumed Killed in Guinea with Discovery of 8 Bodies

In Guinea, a team of three doctors and three journalists, which went missing Tuesday, appears to have been murdered as they attempted to educate locals about the epidemic. Villagers in Wome (Wamey) pelted the team with stones after they visited the village, and a journalist who escaped the villagers could hear them searching for her as she hide. Rumors have circulated in this region of Guinea that health workers were purposely infecting people with Ebola, and many people do not believe that Ebola exists and some refuse to cooperate with health authorities.

Delays of days in Ebola test results are forcing burial teams to leave corpses for days, sometimes burying them before test results are known due to foul odors. The burial teams are significantly understaffed as calls to an Ebola hotline are often unanswered due to a shortage of workers. China has begun to setup a mobile Ebola testing lab in Sierra Leone, along with the placement of 59 person team in the country composed of 30 doctors and 20 lab technicians. The Chinese team will be based at the Friendship Hospital in Jui, 30 kilometers southeast of Freetown. China has a total of 174 medics in Liberia, Sierra Leone and Guinea.

France to setup field hospital in isolated region of Guinea

France has said that it will setup a field hospital in the the “forests of Guinea, in the heart of the outbreak.” Presumably this is a reference to the isolated region of Guinea, near the borders of Sierra Leone and Liberia which has been, to a certain degree, quarantined by these three countries.

MSF Rejects $2.5 million in funds from Australia

Doctors Without Borders, (MSF), recently rejected $2.5 million in donations from Australia, describing the funds as “useless” without logistical support and more personnel. MSF says that money would be better spent in the hands of state governments, such as Australia, in order to provide things which MSF can not buy such as more medical trained personnel on the ground, and helicopter transportion. As Dr. Jackson Naimah of MSF said in an address to the UN from Monorovia, Liberia:

“Please send your helicopters, your centers, your beds and your expert personnel. But know that we also need the basics" like soap, water and buckets, Naimah said. "We do not have the capacity to respond to this crisis on its own. If the international community does not stand up, we will be wiped out.”

And as a top MSF official in Australia, Paul McPhun, said:

"Let's be very clear. It's not MSF's role nor should it be to substitute the responsibility of the Australian government or any other state in addressing this (epidemic).”

Healthcare Workers Needed

Though the US has committed to opening up at least 17 treatment centers in Liberia, with approximately 100 beds each, it appears that the White House expects a large number of NGO/foreign government healthcare workers to flood into the region in the coming months to help staff these treatment centers.

In anticipation of a flood of foreign healthcare workers that has yet to materialize, the US military has plans to setup a 25 bed portable hospital to be used exclusively for the treatment of foreign healthcare workers, some of whom will be offering aide in west africa without a guarantee that their home country will evacuate them home should they become infected with the ebola virus.

It remains to be seen if the US military will be able to find enough foreign healthcare workers to staff the planned 17 Ebola treatment centers.

According to Raphael Frankfurter, who is the executive director of the Wellbody Alliance, the “key gap” is a lack of healthcare workers, leaving some Ebola treatment centers with just one doctor, and no nurses, nurses’ aides, or sanitation workers, and because of this patients are often left alone at night. Healthcare workers that are there are forced to work long shifts in isolation gear that can become extremely uncomfortable in the heat.

Liberia’s Healthcare System Unable to Cope with Non-Ebola Medical Issues

In the town of Foya, about 270 miles from Monrovia, a Measles outbreak has occurred, possibly because the government and/or foreign aid groups has fallen behind with measles vaccinations.

Due to the ebola outbreak, pregnant women are far less likely to receive prenatal care, and are far less likely to have their delivery attended by a skilled birthing attendant. Sister Barbara Brillant, the national coordinator of the Liberian Catholic Church’s health and has lived in the country 37 years says that patients with broken legs and appendicitis are out of luck. Some hospitals are refusing to operate on appendicitis patients out of the fear of Ebola.

Ivory Coast Arrests People from Guinea Attempting to enter the country illegally

The Ivory Coast government “intercepted” seven people from Guinea who tried to enter the country illegally by bypassing a border checkpoint. Due to Sierra Leone’s three day lockdown, some of its citizens have fled to Guinea. The Ivory Coast shares a border with both Guinea and Liberia.

Sierra Leone Lockdown Ends

The government of Sierra Leone has said that 75% of “targeted” houses, out of 1.5 million households, was contacted by volunteers during the controversial three day lockdown. Sierra Leone has a population of about 6 million people, and earlier a government official had hinted that the lockdown would be extended as the volunteers did not finish contacting people living in metropolitan areas such as Freetown and Kenema. Freetown has a population of approximately 1.2 million residents, and Kenema has about 188,000 residents. Now, officials in Sierra Leone have said that the lockdown will not be reinstated as the objective have largely been met.

92 bodies were recovered, and 123 people contacted authorities regarding suspected infections, and reportedly at least 56 new Ebola infections were confirmed with positive lab results.

As volunteer passed out bars of soap to households under lockdown, rumors of poison in the soap spread in some neighborhoods, and doubtlessly some people with symptoms suggestive of Ebola fled, or were hidden by their families.

As Sierra Leona now is reporting approximately 35 new official Ebola cases per day, the 56 new infections discovered over three day lockdown, with possibly many more missed by the government, is suggestive that the so-called "grey areas" of undetected Ebola transmission and mortality do exist. It seems reasonable to estimate that the true number of weekly infections in Sierra Leone might be at least double that of the official number of reported cases, though some of these cases may have traveled to treatment centers on their own were it not for the lockdown.

Traditional Burials Continue in Some Areas of Guinea Despite the High Risk of Ebola transmission

In at least some areas of Guinea, traditional burials, in which the dead are washed, continue despite the high risk of transmission of the Ebola virus.

Daniel Bausch, an Ebola expert who has lived in in Sierra Leone and Guinea this year recently gave an interview with NPR. Bausch said with regards to the US scale-up:

“So I was happy to see the announcement by Obama. But it’s true that when you say we’re going to train 500 people a week, who are those 500 people, right? But it’s not like there’s 500 workers (in Sierra Leone). You probably could name all the nurses in the country and it might not get to 500.”

Bausch also said that running a safe Ebola ward means more than gloves and googles, that there needs to be a high-level of staffing such that Ebola patients with delirium who crawl out of bed and contaminate an area with perhaps vomitus, or another bodily fluid, are returned to bed and the area is disinfected.

Bausch described the running of one treatment center Kenema Sierra Leone as perhaps borderline unethical in that it wasn’t done properly, and healthcare workers were getting infected, yet they knew that if they released 60 Ebola patients back on to the streets, and back home, that many more people could become infected.

Bausch has said that Ebola patients lose a large amount of fluids through vomitus and diarrhea, and that IV fluids could make a difference for a lot of patients, but they don’t have the staff to administer the IV fluids.

60 WHO Experts in the New England Journal of Medicine recently wrote that it is possible that Ebola could become endemic in western Africa, and that the true number of Ebola cases is likely higher than reported as some symptomatic people have avoided contact with hospitals and the authorities, some lab confirmed Ebola positive diagnosis are not being reported, and some bodies are being buried without an Ebola test being done.

CDC predicts possibly as many as 1.4 million actual Ebola cases at the end of January

Assuming that Ebola cases are underreported by a factor of 2.5, the CDC is predicting that the actual number of Ebola cases will be between 550,000 and 1.4 million in January, assuming that relief and isolation efforts aren’t drastically increased in the interim. In fact, these estimates are based on data through August 2014, and there is hope that recent pledges from the US government will, and perhaps already have, altered the trajectory of epidemic. Nonetheless, the doubling time for the number of Ebola cases in the region is now around 26 days. The epidemic in Guinea, based on official numbers, appears to have leveled-off a bit in the past couple weeks, though this could change in the future. The CDC estimates are based on the rapidly growing number of Ebola infections in Liberia and Sierra Leone.

Looking at just the number of reported cases, and assuming continued exponential growth with a 26 day doubling time:

October 26th: 14,000 Official Ebola cases

November 22nd: 28,000 Official Ebola cases

December 18th: 56,000 Official Ebola cases

January 13th: 112,000 Official Ebola cases

February 8th: 224,000 Official Ebola cases, with possibly 448,000 to 896,000 actual Ebola Cases, or if Doctors Without Borders is correct and the confirmed Ebola cases are only 20% of the actual case load, then the actual number of cases would be about 1.1 million.

Doctors Without Borders Has Criticized Liberia’s Plan for Ebola Community Treatment Centers

Liberia is planning on building ‘ad hoc’ treatment centers where people presumed to be infected with Ebola are moved out of their homes and provided with rudimentary care, such as food, water and pain medication; as per the Washington Post:

Though the US is committed to building facilities to add 1,700 more beds for Ebola patients, it may take weeks to months to build said facilities, to say nothing of finding healthcare workers to properly staff even a portion of them.

Brice de le Vigne, MSF’s director of operations, has warned that without proper safety protocols, trained staff, regular supervision and supplies, these planned community treatment centers could become, in his words, “Contamination centers.”

Possible Highly Effective Ebola Treatment for those with early symptoms

CNN is reporting that a Liberian doctor, Dr. Gobee Logan, has discovered that the HIV medication lamivudine may have cured 13 out of 15 Ebola patients given the medication by Dr. Logan. Notably, all 13 of the survivors received lamivudine within five days of reporting symptoms, and the two patients who died were five to eight days into their illness. Before turning to lumivudine, Dr. Logan treated Ebola patients with acyclovir without noticeable success.

If these results are replicated in expected other ad hoc trials, the use of lamivudine might significantly alter the trajectory of the Ebola epidemic and prevent Ebola from establishing itself endemically.

UNICEF reports that 3,700 children in Liberia, Sierra Leone, and Guinea, have lost one or both parent to Ebola. Though orphans are usually taken in by family members, Ebola stigma complicates this matter in this unfolding humanitarian crisis, and children may shunned, perhaps given food but avoided by everyone in a village. UNICEF will train 400 mental health workers and social workers, and will train 2,500 Ebola survivors, who are immune, to provide care for quarantine children and help them find their relatives if possible.

UN Mission to Combat Ebola Opened in Ghana on Monday

The United Nations Mission for Ebola Emergency Response, UNMEER, will be building and analyzing maps describing the virus’s prevalence, as well as hotspots, in order to determine where resources should be sent.

Anthony Banbury, in charge UNMEER has laid out UNMEET shorter goal in the next two months as, "70 percent of infected people need to be under treatment, 70 percent of burials need to be done in a safe way.”

Ebola Not Spreading Nearly as Fast as Measles Before Vaccinations

Dr. Gerardo Chowell-Puente, a mathematical epidemiologist, noted in a recent Time article that each measles case, before routine childhood vaccinations, produced 17 secondary cases on average. The 1918 flu pandemic produced between 2 and 5 secondary cases for each case of this flu virus, but had a “generational interval” of between 2 and 3 days, the amount of time between one case catching the virus and it being passed on to a secondary case.

The good news is that Ebola, when looking past outbreaks, produces just 1.3 to 1.8 secondary cases per case on average, and it is not believed that this strain of Ebola has somehow become more transmissible. The generational interval for Ebola is about two weeks, which is enough time for symptomatic Ebola patients to be identified and be isolated.

MSF, Doctors Without Borders, has reported this week that 16 members of its staff have contracted Ebola, and nine have died from the disease. A large majority of MSF's staff is drawn from local populations, and it is unclear if any local MSF staff have been evacuated to western countries where advanced supportive care such as kidney dialysis and various types of blood product transfusion can be made available to patients in an intensive care setting.

In total, 400 healthcare workers have contracted Ebola, and 250 healthcare workers have died so far.

Unclear if United States Ebola Precautions Include Chlorine Solution Spray Down

While MSF treatment centers in West Africa have been using a chlorine solution spray down for healthcare workers exiting "dirty" Ebola treatment centers, (something which is easy enough to do in hastily constructed outdoor treatment centers), it is unclear if American hospitals are considering adding such a step to the decontamination procedure of healthcare workers attending to Ebola positive patients.

Even putting on personal protective equipment in order to treat Ebola positive patients is an arduous process, and one with a small, but finite, error rate.

In order to circumvent a decree from Liberia's President that dead bodies be cremated in Liberia, it has been reported that families are hiding sick loved ones and burying their bodies in secret in order to avoid cremation and ostensibly to have a physical grave site in which to mourn the deceased. Some ebola victims are buried in body bags in locations without relatives present, leaving some to wonder where their relatives have been buried. The care of relatives at home, and the private burial of ebola victims is worrisome as such activity might increase the transmission of the ebola virus.

Distrust of national governments runs high in these affected regions of West Africa, and there are reports that ebola burial teams can be bribed to either leave Ebola bodies in villages (when they should be removed and cremated), and that the burial teams can also be bribed to give a death certificate indicating a cause of death other than Ebola, which then allows families to legally bury the body on their own.

One of the reasons why the death rate for this Ebola epidemic was first reported at around 50%, (and is now estimated to be closer to 70%), is that the cause of death was often changed to hide the deceased positive Ebola status.

Korto Williams, ActionAid Country Director in Liberia, has noted that in the past week in Liberia there has been a lull in the visible number of Ebola cases in the country, and that ambulances are bringing fewer Ebola victims to treatment centers.

Amazingly, beds at ebola treatment centers are about half-full, a recent survey indicated that of 742 available beds only 351 were presently occupied.

Yet Williams remarks that she believes that cases will eventually pick back up again.

It has become apparent that some Liberian families are hiding family members potentially sick with Ebola, and burying their bodies on their own should they die. They are doing this in order to circumvent an order by Liberia's President declaring that all bodies be cremated. This development is troublesome as the corpses of Ebola victims are known to be especially infectious.

A coordinator working with the Ministry of Health in Liberia, and the Red Cross, has said that burial teams are called to bury 10 to 30 corpses each day, down from the 30 to 80 corpses which were disposed of each day in the months of August and September.

Due to a lack of understanding of the basic biology behind Ebola, some families are afraid to tell health workers even how many people live in their home, believing that revealing this information may cause them to somehow contract Ebola themselves.

MSF has reported that one of its Ebola treatment centers in Liberia has no patients at the moment, though it has reiterated that the Ebola epidemic is spreading alarmingly fast in both Sierra Leone and Guinea and that the epidemic in Liberia could flare up again in the coming months, as has occurred most dramatically in Guinea and Sierra Leone.

The reasons for the decrease in reported cases is not fully known. Natasha Reyes, MSF's Ebola treatment coordinator in Liberia has acknowledged that MSF is not aware of what is occurring outside of their treatment centers.

Resurgent Ebola Epidemic in Guinea Could be Due to Reverse Migration

Reportedly, one reason for the resurgent Ebola epidemic in Guinea is that people who have lived in Liberia and Sierra Leone the past months have been migrating back to family in Guinea since the Ebola epidemics have since June become much worse in Liberia and Sierra Leone. Marc Poncin with MSF in Guinea has recently reported that the epidemic in Guinea says that since mid-August there has been a regular increase of cases each week in Guinea, and it is unknown when they will hit the peak number of cases.

Poncin also notes that in addition to treatment, there is a need for good surveillance and contact tracing otherwise, health care workers will have to, “run after the epidemic, like we've seen in Liberia.”

Perhaps in some respects, the Ebola epidemic has already shifted away from certain treatment centers and districts in Liberia over into Guinea and Sierra Leone.

Despite the fact that Ebola has affected every district in Sierra Leone, the five worse affected districts are under quarantine, with roadblocks to prevent people from leaving and entering, a move which directly effects between 1 and 2 million people. Approximately 85% of calls to Ebola hotlines are unanswered, and “transit centers” where people suspected of having Ebola are overcrowded and some people who are not positive for Ebola, but have symptoms, are being sent directly to Ebola treatment centers.

There is a lack of ambulances, treatment center beds and labs available to test for Ebola in Sierra Leone, and people with other medical conditions are having great difficulty obtaining medical care. For example, pregnant women who require C-Sections may not be able to get them, and may die as a result of doctors who are too afraid to perform such procedures which are perceived to be “high risk” in terms of transmission of the Ebola virus.

Push for Mobile Ebola Treatment Units, Currently less of a need for massive urban Ebola Treatment Centers in Liberia

Amid reports of a waning Ebola epidemic in some areas of Liberia, American and Liberian stakeholders are pondering if the U.S. should continue with its plan to build 17 100-bed Ebola treatment centers, or if the money should be put to other use, such as preparedness for future Ebola outbreaks, or for providing mobile Ebola treatment centers which could better tackle the epidemic in Liberia. One U.S. financed Liberian Ebola treatment center has opened, with two more planned to open at the end of November, and another seven in various stages of construction.

Doctors Without Borders, MSF, has issued a call for a ‘change in tactics’ in Liberia, noting that while its 250-bed treatment center in Monrovia has just 50 beds, new hot-spots are emerging around the country all the time. MSF would like to see the creation of mobile rapid response that are equipped to tackle Ebola flare-ups in the country.

For example, the village of Jene-Wonde in Liberia weeks ago became a new epicenter for the epidemic when a schoolteacher brought him his sick daughter from the capital. Soon he, and his entire family was dead, and a number of residents in this village have contracted Ebola. Residents of Jene-Wonde initially chased away safe-burial teams and would hide the sick from outside healthcare workers. There is limited healthcare resources currently available in this village, and the situation in Jene-Wonde appears to parallel an existing trend of Ebola moving from urban centers to isolated rural areas.

Somewhat logically, the Ebola epidemic began as a rural phenomenon that took root quickly in heavily populated urban areas where transmission of the virus is easier and where contact tracing is much harder. Given the travel between urban and rural areas in West Africa, it could perhaps have been predicted that the virus would seed multiple rural hotspots over the coming months.

American officials have also recently said that perhaps only 3,000 American troops will be needed in the region, down from an early estimate of 4,000. The Obama administration is asking Congress for an additional $6 billion to tackle the Ebola epidemic at home and abroad.

Maternal Mortality Rate Could Skyrockett 20 Fold in Affected Countries in West Africa

Due to a lack of basic healthcare services, as well as the fear of contracting Ebola among healthcare providers, there are concerns that the maternal mortality could increase 20-fold from a rate that was already considered high compared to western countries before the Ebola epidemic began. It is estimated that one in seven pregnant women could die due to a lack of basic treatment for common complications of pregnancy. One clinic run by MSF actually stopped accepting pregnant patients in July as they deemed the risk too high for their staff, though the charity has said in weeks past that it hopes to return to providing care for other medical problems affecting women and children once the Ebola epidemic is brought under control.

West African Countries on Periphery of Ebola Epidemic

As expected, a number of Ebola cases have appeared in a country peripheral to the Ebola epidemic, Mali, which shares a border with Guinea. Two separate infection chains were started by the migration of two separate Ebola positive people into Mali. One of the chains was successfully terminated with quarantining, and due to the chance occurrence that the 2 year old child who died from Ebola apparently did not pass on the virus. The second Ebola carrier, an imam who contracted Ebola in Guinea then traveled to Mali for better treatment, in Mali he and an attending nurse died. A doctor who presumably cared for this patient has also tested positive for Ebola.

Given that the Ivory Coast shares a border with both Liberia and Guinea, it is expected that a number of people infected with Ebola will cross this nation’s border at some point in the coming months, though the country has taken some precautions to localize and contain a future Ebola outbreaks within its borders.

US to Significantly Reduce Both Number of Ebola Treatment Centers and Size

Due to a perceived decrease in the number of new Ebola cases in the West African country of Liberia, the US has scaled back the number of planned Ebola Treatment Centers from 17 to just 10, and the number of beds per treatment center will be scaled back from 100 to 50, meaning that instead of 1,700 beds, the total number of beds in these treatment centers will be just 500. Even if all 10 treatment centers are built, the US has not committed to staffing any of these treatment centers.

Though the growth of the number of reported Ebola cases in Liberia has slowed to about 60 reported infections per day, some aid organizations believe that the ebola epidemic has simply moved into neighboring countries, perhaps migration out of Liberia to Sierra Leone and Guinea due to Liberia's presidential decree that all bodies be cremated in Liberia.

In the wake of the Ebola epidemic, 2/3'rds of the healthcare facilities in Liberia are closed or operating below normal capacity.

Even though the number of new Ebola cases in Liberia has "stabilized", it is obvious that the current estimates of 20 to 50 new Ebola cases per day in Liberia means that the epidemic there is still ongoing and could flare-up again at a future date.

Man quarantined in India Due to 'Traces' of Ebola Virus in his semen

A man who had been "cured" of Ebola in West Africa, and had paper work attesting to this fact, nonetheless was found to have Ebola virus in his semen and was put under isolation in Dehli. Some experts believe that the Ebola virus may live as long as 90 days in men's semen after Ebola infection, complicating efforts aimed at longterm eradication of the Ebola virus in West Africa and abroad.

In response to evidence that the Ebola virus is detectable in semen for up to 82 days after the first appearance of symptoms, the WHO is asking men to abstain from sex for three months after the onset of symptoms, or to use condoms.

It is uncertain if this ‘detectable’ Ebola virus in men’s semen is actually viable and therefore capable of infecting another person. Also, while Ebola virus has likewise been detected in vaginal secretions, apparently the WHO has made no similar recommendations regarding women recovering from Ebola.

Ebola Virus Co-Discoverer/Director of LSHTM Says Ebola Fight Could Continue for Another Year

Peter Pior, who co-discovered the Ebola Virus in 1976 in the DRC (what was then Zaire), and who is now the director of the London School of Hygiene and Tropical Medicine, has predicted that the fight to end the West African Ebola outbreak will continue well into 2015, though he is encouraged by the opening of much needed treatment centers in Sierra Leone.

The waxing and waning of the epidemic is described, such as how Samaritan's Purse and MSF pulled out of Liberia in May when they believed that the epidemic there had ended, meanwhile the virus was spread silently in Sierra Leone and it is believed that from there the epidemic in Liberia was rekindled. During the annual WHO assembly on May 19th in Geneva, WHO Director Margaret Chan mentioned Ebola only once, and in passing, and many believed that the epidemic would be stamped out soon.

About a month later, on June 21st, MSF (Doctors Without Borders) declared the Ebola epidemic in West Africa as being "out of control." On August 8th, the WHO would declare the Ebola Outbreak a public health emergency of international concern, and Margaret Chan would asked the WHO regional directors in Sierra Leone, Liberia, and Guinea, (officials heavily criticized for being political appointees), to resign so that those with experience managing crises could be put in charge.

The WHO believes that intravenous fluids, and laboratory blood chemistry monitoring, is the reason why Ebola patients have a much better prognosis in modern healthcare facilities with standard supportive care, versus the limited care given in many Ebola treatment centers in West Africa were intravenous fluids are not given for a variety of reasons, most of them practical.

MSF is now being criticized for not providing intravenous fluids, especially given the influx of aid workers and additional resources. Some experts believe that raising the standard of care for ebola patients in west africa could drastically decrease the mortality rate. In field, however, giving Ebola patients IV fluids has proven to be a difficult challenge, given that healthcare providers must insert IV lines with foggy goggles, and that the patients, who are often delirious, are at risk of pulling out their IV lines. A practical solution might be to use intraosseous needles to deliver replacement fluids to ebola patients through their bone marrow as the placement of such lines requires only a special "IV gun" and the line is less likely to be physically pulled out. Nonetheless, some doctors are concerned about the 'optics' of being seen using bone needle guns on patients given earlier rumors of organs being harvested in ebola treatment centers early on in the epidemic.

Normally, doctors without borders gives their patients IV fluids, but this ended in September when the number of Ebola patients surged and doctors could spend only one minute with each patient given the sweltering conditions of working in isolation suits in the hot weather.

An Ebola treatment unit in Hasting Sierra Leone was able to decrease the mortality rate by about half, from 48% to 24% by giving new ebola patients immediate IV fluids, as well as other medication such as antimalarials, antibiotics, and medications to prevent vomiting, which can lead to fluid loss and electrolyte disturbances. About half of the labs in west africa can test for electrolyte disturbances, though some clinical practitioners are giving moderate electrolyte replacement before lab results are known to patients whom it is deemed safe, such as those who are producing urine and believed to have functioning kidneys.

Dr. Adaora Igonoh, a 28-year-old Nigerian physician who contracted Ebola and recovered credited her survival with forcing herself to drink fluids despite vomiting and dislike the of the salty taste.

Number of New Ebola Cases in All of West Africa Plunges to Just 100 per Week

It was recently reported that the total number of new officially reported Ebola cases plunged to 100 per week in West Africa. There has been a shift away from building Ebola treatment centers, many of which are now empty, towards contact tracing in which Ebola patients contacts are monitored and/or isolated if need be. Contact chains are often obscure as only 50% of known Ebola patients in Liberia are contacts of other known patients, that number drops to 30% in Guinea, and is an unknown in Sierra Leone.

Asymptomatic Ebola Virus Carriers Identified

Scientists at the Pasteur Institute have identified asymptomatic people who were at some point infected with the Ebola virus, raising the specter of chains of Ebola virus transmission which are more difficult to trace. Given the relatively high mutation rate of the Ebola virus, scientists are investigating whether a mutated form of the Ebola virus has emerged, possibly one which is less lethal for the human carrier, but which may evolve to become more infectious. Some scientists have speculated that the drop-off in new Ebola infections is due in part to a growing population of asymptomatic people who were at one point infected with the Ebola virus and have developed a level of immunity.